By Christian Regalado
It’s been a busy year for health insurance. Some big changes happened in Medicare prescription coverage for 2025 and many people on individual plans had noticeable premium changes. If you have Medicare Advantage and take prescription drugs pay attention starting in January. Prices on next month’s prescriptions may surprise you. If this happens and you have a Medicare Advantage plan you may want to give me a call. If this happens and you have a stand-alone PDP plan, you may want to contact your doctor to see if there are other drugs that are on your plan’s formulary to substantially lower your costs. Feel free to contact me if you need some clarity and advice.
Baby Boomers are still turning 65 at record numbers. We are fortunate that there are many choices of Medicare plans available in the South Walton/Destin area. Most people end up with one of the many Medicare Advantage plans available here. More and more folks are signing up on Medicare Supplement and Prescription Drug plans, which provide excellent coverage.
Which one is best for you? It all depends on your particular needs and how you plan to use your Medicare plan. That is where a broker can be helpful by asking questions and guiding you to the plan and insurance carrier that best fits your needs. It can be a confusing process but a local broker is a great asset to help navigate the many options.
When you read this, it will be after the end of the Annual Enrollment Period on December 7. This is the annual opportunity to change your Medicare Advantage plan or Prescription Drug Plan (PDP) for a January 1 effective date. If you missed this and would still like to make a change, you can still do so for an Advantage plan between January 1 and March 31 but it’s too late to change a PDP plan.
Medicare had many changes in 2025. This was primarily due to the Medicare prescription maximum out of pocket being reduced from $8000 to $2000 starting in January of 2025. Great news for those with expensive drugs but it allowed the insurance companies to spread their loss of income to other Medicare members which resulted in most PDP plans going up in cost and Advantage plans reducing some benefits. Every insurance carrier reduced or eliminated some benefits, mostly for dental. Drug formularies changed, which is the list of drugs that each carrier publishes showing which prescription drugs are included in their plans. If a drug is not included in a carrier’s formulary, it is not subject to the $2000 maximum out-of-pocket cost. So be careful since a drug covered in 2024 may not be covered in 2025. This could result in very high prescription costs not covered by insurance.
Unfortunately, some people won’t realize this until they refill their prescription next year. Keep in mind that if this happens to you, there may be an opportunity to change your Advantage plan. Call for details.
If you are interested in changing plans on the Individual Market Place you have until Jan. 15 to switch plans for 2025. I wish there were insurance plans on the individual Marketplace that were anywhere close to Medicare, but there aren’t. However, if you would like to discuss other options, I’d be happy to help you know what they are. Reach out anytime.
I want to say a big thank you to everyone that has reached out to me over the last two years that I have been contributing to this paper. I have very much enjoyed the many relationships I have been fortunate to make. I also really appreciate the referrals. We have some great neighbors here around 30A. Genuinely.
Have a very merry Christmas!!
Please remember that our services are free, and we can do consultations over the phone or at your home, but I also welcome clients to visit my office in Santa Rosa Beach. I am certified with many different insurance carriers, and I am happy to answer your questions and assist any way I can.
Email me at christian@evergreenhealthins.com or call (850) 687-7606.
Author: Sowal Editor
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